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9. A 21-year-old student presents to ED reporting with chest pain and non-produc

ID: 267943 • Letter: 9

Question

9. A 21-year-old student presents to ED reporting with chest pain and non-productive cough that began 1 week ago. His sympotoms are progressing, and he now has a low-grade fever, productive cough, weakness, hemoptysis and anorexia. Chest X-ray reveals an infiltrate in an upper left lobe of the lungs. Culture of the infiltrate reveals fungal elements of Blastomyces dermatitidis. The patient was started on an intravenous antifungal. Two weeks later patient’s serum creatinine is significantly elevated. Which of the following was most likely prescribed for this patient? A. Clotrimazole B. Itraconazole C. Colloidal amphotericine B D. Voriconazole

10. An HIV-infected patient develops rapidly progressing cryptococcal meningitis. He was hospitalized and treated with Amphotericin B and flucytosine. What therapy would you recommend after his release from the hospital for prophylactic therapy? A. Clotrimazole B. Fluconazole C. Metronidazole D. Itraconazole

11. Antibiotics are commonly administered before surgical procedures. Which of the following statements best describes the guidelines for perioperative antimicrobial prophylaxis? A. Administer the antibiotic just prior the procedure B. Begin antibiotic prophylaxis at least 24 hours before surgery C. Select the broadest spectrum antibiotic for complete coverage D. Use antibiotic combinations as opposed to monotherapy.

12. When using combination antibiotic therapy, it is important to administer drugs that work synergistically as possible. Which of the following represents a combination with known synergism? A. A beta-lactam and an aminoglycoside B. A penicillin and a cephalosporin C. Two drugs in which the second drug will displace the first from plasma protein-binding sites. D. Two drugs that are eliminated by different routes E. Two drugs that work on the same step in a metabolic pathway.

13. A 29-year-old Asian woman is being treated for a vancomycin-resistant enterococcus infection. She is also taking a serotonin inhibitor for depression. Which of the following antibiotics should be avoided in this case? A. Chloramphenicol B. Gentamicin C. Linezolid D. Telitromycin E. None of these

14. An antibiotic is administered once daily in the intensive care unit to treat sepsis caused by an abdominal wound. Serum and urine concentrations of the drug are monitored during the course of therapy. Ten days after therapy is discontinued, the drug is still detectable in urine. Which of the following antibiotics was administered? A. Azithromycin B. Chloramphenicol C. Doxycyclin D. Gentamicin

15. Protease inhibitors are primarily metabolized by the P450 system, and the metabolism of other drugs can be altered in patients taking them. Which of the following drugs has the greatest potential for drug-drug interactions? A. Ritonavir B. Saquinavir C. Stavudine D. Zalcitabine

Explanation / Answer

9) Colloidal amphotericine

10) Itraconazole

11) D. Use antibiotic combinations as opposed to monotherapy.

12) A beta-lactam and an aminoglycoside

13) C. Linezolid

14) Azithromycin

15) Ritonavir